go back

Tumor Marker Test, Positive or Negative

Virginia rates for HCPCS 86294

An antibody-based laboratory test that looks for a tumor-associated substance in a sample and reports the answer as positive or negative, or as a rough level, rather than an exact figure. A common use is checking urine for a bladder cancer marker in someone being monitored after treatment.

Rates data updated October 2026.

How much does Tumor Marker Test, Positive or Negative cost?

$19.95

Typical negotiated rate. In Virginia, October 2026.

Insurers have agreed to pay about $19.95 for this service. The price depends on where it is billed: about $17.78 from a physician practice, and about $33.11 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 8 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$17.78$15.49 to $20.42
FacilityA hospital or hospital-owned outpatient department$33.11$25.70 to $61.66

How much rates vary

Facilitymedian $33 · 10th to 90th $23 to $120Professionalmedian $18 · 10th to 90th $13 to $30
$10$100$1K$10Kfacility $33professional $18

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$19.05
Median
$21.88
Typical High
$58.88
Aetna
Setting
Professional
Modifier
None
Typical Low
$19.05
Median
$21.88
Typical High
$22.91
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$25.70
Median
$25.70
Typical High
$125.89
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$12.59
Median
$15.49
Typical High
$19.50
CareFirst
Setting
Professional
Modifier
None
Typical Low
$18.62
Median
$20.42
Typical High
$24.55
Cigna
Setting
Facility
Modifier
None
Typical Low
$26.30
Median
$50.12
Typical High
$77.62
Cigna
Setting
Professional
Modifier
None
Typical Low
$12.88
Median
$20.42
Typical High
$33.88
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$25.70
Median
$30.90
Typical High
$38.02
Medcost
Setting
Professional
Modifier
None
Typical Low
$9.55
Median
$33.11
Typical High
$38.02
Medcost
Setting
Facility
Modifier
None
Typical Low
$16.22
Median
$21.88
Typical High
$39.81
Medcost
Setting
Professional
Modifier
None
Typical Low
$20.42
Median
$20.42
Typical High
$24.55
Sentara
Setting
Facility
Modifier
None
Typical Low
$19.95
Median
$31.62
Typical High
$10,232.93
Sentara
Setting
Professional
Modifier
None
Typical Low
$20.42
Median
$31.62
Typical High
$10,232.93
United
Setting
Facility
Modifier
None
Typical Low
$30.90
Median
$30.90
Typical High
$30.90
United
Setting
Professional
Modifier
None
Typical Low
$10.23
Median
$13.49
Typical High
$24.55
2 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$9.55
Median
$10.96
Typical High
$11.48
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$3.80
Median
$4.37
Typical High
$4.57

Where Virginia sits

The same service costs 3.8 times more in Alaska than in Alabama. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Virginia· 39th of 51

$19.95

AK $57.54AL $15.14

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.